Yonsei Med J.  2014 May;55(3):570-575. 10.3349/ymj.2014.55.3.570.

Unrecognized Kinetics of Serum Testosterone: Impact on Short-Term Androgen Deprivation Therapy for Prostate Cancer

• Koo KC
• Lee DH
• Kim KH
• Lee SH
• Hong CH
• Hong SJ
• Chung BH

• KMID: 2068664
• DOI: http://doi.org/10.3349/ymj.2014.55.3.570

Abstract

PURPOSE
To evaluate the kinetics of serum testosterone (T) recovery following short-term androgen deprivation therapy (ADT), as the understanding thereof is essential for the proper management of prostate cancer (PCa), especially intermittent ADT.
MATERIALS AND METHODS
This prospective analysis included male sex offenders who voluntarily received leuprolide acetate in order to alleviate sexual aberrance. Thirty-three and 25 patients who received 3 and 6 months of ADT were assigned to Group A and Group B, respectively. Serum T levels were obtained every week during the on-cycle period, then monthly during the off-cycle period for at least 12 months.
RESULTS
The kinetics of serum T during the on-cycle period were similar in both groups. After flare reaction at week 2, a nadir of 0.45+/-0.29 ng/mL was achieved. In Group A, an abrupt rebound-upsurge was observed during the first 2 month off-cycle period, which surpassed the baseline level and reached a plateau level of 8.74+/-2.11 ng/mL during the flare (p<0.001). This upsurge was followed by a gradual decline back to baseline over the following 10 months. In Group B, a gradual increase was observed, and a baseline level of 7.26+/-1.73 ng/mL was reached at 5 months. Thereafter, an ongoing upsurge that surpassed baseline levels was observed until 12 months (8.81+/-1.92 ng/mL; p=0.002).
CONCLUSION
The kinetics of serum T recovery during the off-cycle period varied according to the duration of ADT. Serum T should be monitored beyond normalization, as an excessive rebound may improve quality-of-life, but hamper the treatment efficacy of PCa.

Keyword

Androgens; kinetics; testosterone

MeSH Terms

Adult
Androgen Antagonists/*therapeutic use
Follicle Stimulating Hormone/blood
Humans
Luteinizing Hormone/blood
Male
Middle Aged
Prospective Studies
Prostatic Neoplasms/*blood/*drug therapy
Testosterone/*blood
Treatment Outcome
Young Adult
Androgen Antagonists
Follicle Stimulating Hormone
Luteinizing Hormone
Testosterone

Figure

• 

  Fig. 1 Trends of mean serum testosterone (ng/mL), luteinizing hormone (mIU/mL), and follicle-stimulating hormone (mIU/mL) recoveries during on- and off-cycle periods of 3-month androgen deprivation therapy with leuprolide acetate. LH, luteinizing hormone; FSH, follicle-stimulating hormone; ADT, androgen deprivation therapy.

• 

  Fig. 2 Trends of mean serum testosterone (ng/mL), luteinizing hormone (mIU/mL), and follicle-stimulating hormone (mIU/mL) recoveries during on- and off-cycle periods of 6-month androgen deprivation therapy with leuprolide acetate. LH, luteinizing hormone; FSH, follicle-stimulating hormone; ADT, androgen deprivation therapy.

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